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Tansley G, Schuurman N, Bowes M, Erdogan M, Green R, Asbridge M, Yanchar N. Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia. Can J Surg 2019; 62:123-130. [PMID: 30907993 DOI: 10.1503/cjs.004218] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport. Methods Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression. Results Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98–14.5, p = 0.053). Conclusion Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients.
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Affiliation(s)
- Gavin Tansley
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Nadine Schuurman
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Matthew Bowes
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Mete Erdogan
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Robert Green
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Mark Asbridge
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
| | - Natalie Yanchar
- From the Department of Surgery, Dalhousie University, Halifax, NS (Tansley); the Department of Geography, Simon Fraser University, Burnaby, BC (Schuurman); the Nova Scotia Medical Examiner Service, Dartmouth, NS (Bowes); Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Halifax, NS (Erdogan, Green); the Department of Critical Care, Dalhousie University, Halifax, NS (Green); the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Asbridge); and the Department of Surgery, University of Calgary, Calgary, Alta. (Yanchar)
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Erdogan M, Kureshi N, Karim SA, Tallon JM, Asbridge M, Green RS. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. BMJ Open 2018; 8:e024190. [PMID: 30429147 PMCID: PMC6252682 DOI: 10.1136/bmjopen-2018-024190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing. DESIGN Retrospective cohort study. SETTING Tertiary trauma centre in Halifax, Canada. PARTICIPANTS 2306 trauma patients who required activation of the trauma team. PRIMARY OUTCOME MEASURE The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing. RESULTS Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend. CONCLUSIONS At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.
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Affiliation(s)
- Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Nelofar Kureshi
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John M Tallon
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Sharda P, Haspani S, Idris Z. Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience. Asian J Neurosurg 2015; 9:203-12. [PMID: 25685217 PMCID: PMC4323964 DOI: 10.4103/1793-5482.146605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC). Materials and Methods: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software. Results: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P < 0.001). In biochemical status the significant statistics included evidence of coagulopathy (P < 0.001), evidence of acidosis (P = 0.003) and evidence of hypoxia (P = 0.030). In Radiological sector, significant univariate analysis proved in location of the subdural clot (P < 0.010), location of the contusion (P = 0.045), site of existence of both type of clots (P = 0.031) and the evidence of edema (P = 0.041). The timing of injury was noted to be significant as well (P = 0.061). In the post operative care was, there were significance in the overall stability in intensive care (P < 0.001), the stability of blood pressure, cerebral perfusion pressure, pulse rates and oxygen saturation (all P < 0.001)seen individually, post operative ICP monitoring in the immediate (P = 0.002), within 24 hours (P < 0.001) and within 24-48 hours (P < 0.001) period, along with post operative pupillary size (P < 0.001) and motor score (P < 0.001). Post operatively, radiologically significant statistics included evidence of midline shift post operatively in the CT scan (P < 0.001). Multivariate logistic regression with stepwise likelihood ratio (LR) method concluded that hypoxia post operatively (P = 0.152), the unmaintained Cerebral Perfusion Pressure (CPP) (P = 0.007) and unstable blood pressure (BP) (P = <0.001). Poor outcome noted 10.2 times higher in post operative hypoxia [OR10.184; 95% CI: 0.424, 244.495]. Odds of having poor outcome if CPP unmaintained was 13.8 times higher [OR: 13.754; CI: 2.050, 92.301]. Highest predictor of poor outcome was the unstable BP, 32 times higher [OR 31.600; CI: 4.530, 220440]. Conclusion: Our series represent both urban and rural population, noted to be the largest series in severe TBI in this region. Severe head injury accounts for significant proportion of neurosurgical admissions, resources with its impact on socio-economic concerns to a growing population like Malaysia. This study concludes that the predictors of outcome in severe TBI post DC were postoperative hypoxia, unmaintained cerebral perfusion pressure and unstable blood pressure as independent predictors of poor outcome. Key words: Decompressive craniectomy, prognostication of decompressive craniectomy, prognostication of severe head injury, prognostication of traumatic brain injury, severe head injury, severe traumatic brain injury, traumatic brain injury.
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Affiliation(s)
- Priya Sharda
- Department of Neurosurgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Saffari Haspani
- Department of Neurosciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosurgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
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